Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. Through stories from my behavioral pediatrics practice (with details changed to protect privacy) I will show how contemporary developmental science can be applied to support parents in their efforts to facilitate their children’s healthy emotional development. I will address factors that converge to obstruct such support. These include limited access to quality mental health care, influences of a powerful health insurance industry and intensive marketing efforts by the pharmaceutical industry.

Sunday, April 22, 2012

Engaging Our Right Brains to Support Parents and Children

"People have to feel something in order to change the way they think and behave." This is a quote from my book Keeping Your Child in Mind. The right brain is the seat of emotional regulation. Most, if not all, emotional and behavioral problems are intrinsically tied to the ability to regulate emotions. Changes in the brain can occur only if the right brain centers that regulate emotion are actually firing.

I was thinking about this idea when I attended an amazing conference at the Picower Institute for Learning and Memory at MIT, New Insights on Early Life Stress and Mental Health. Leaders from a range of disciplines presented the explosion of scientific evidence showing that early caregiving relationships have a significant long term impact on both mental and physical health.

MIT is a particularly left brain place, and there was a lot of hard core science at this talk. One speaker, Robert Anda, did inject a bit of right brain experience. Anda is one of the main authors of the ACES study, a powerful longitudinal research project that shows the cumulative effect of adverse childhood experiences, including parental mental illness, divorce, neglect and abuse, on many outcomes related to physical and emotional health. He used art to make our right brains fire. In a painting he showed, a little boy of about seven sat at the dinner table as his parents engaged in an argument, his father holding a knife and his mother's face distorted by rage. The terror on the boy's face was palpable.

The conference was very much framed around the concept of adversity. Anda kept apologizing for making us depressed. Consider the conference description:

Within the last two decades, scientists have begun to examine the biological repercussions of early childhood stress, and have uncovered clues as to how these early life experiences cause lasting changes in DNA and the brain that predispose individuals to disabling behavioral and psychiatric disorders in adolescence and adulthood.

The whole day I found myself thinking that what was missing was a right brain experience of what it feels like when things go well. We know it is bad for kids when they do not have a secure safe relationship. But what does it feel like when parents and children do connect in a way that makes a child feel safe and secure? Earlier in the day I had had the opportunity to share just such a right brain experience.

I had given Pediatric Grand Rounds at Newton-Wellesley Hospital, where I was introducing the scientific basis of my new Social Emotional Health program, where I see families of children under age six. When families come to see me, parents and children feel sad, angry, and out-of-control. By carefully listening to parents' own experience I help them to reflect on the meaning of their child's behavior, rather than responding to the behavior itself. This approach is founded in decades of longitudinal research at the intersection of developmental psychology, neuroscience and genetics that I describe in my book.

I told my audience the story of a visit with a mother who experienced her 3-year-old son's behavior as an assault. I had reframed the child's behavior in these out-of-control moments as helpless rather than defiant. She said, "I know what you mean." She described one moment when, rather than getting angry, she had held her son firmly on her lap and said gently "What's wrong?" She told me how her son "melted in my arms" and replied softly, "I don't know."

This mother felt this change not only in her brain, but in her body. It is not uncommon for parents to have themselves experienced trauma in early relationships. They react to their child's provocative behavior on a physical level that is related to their own history, not to the child. By carefully listening to parents, in a visit that is not fifteen minutes but an hour, I help them to make these connections. Once their own issues are in a sense moved out of the way, they are free to reflect on their child's experience in a way that is not encumbered by their own trauma history. When a child feels understood in this way, his behavior improves. A positive cycle of interaction is set in place.

When I told this story during Grand Rounds, I felt a tingling in my arms as I spoke of this mother's transformation in my office. The visit with that family had been a powerful experience for me. The fact that I felt something in the telling makes me hopeful that I was able to convey this to my audience. Maybe they understood how this kind of careful listening may actually change brains.

My book is full of stories like this one. If we are going to change this path that was described at MIT, of early childhood stress leading to terrible outcomes, these conferences need to include stories of what goes right; when clinician-parent-child connect in a meaningful way. Once we know what this feels like, we will be closer to understanding what we need to do to set children and families on a better path.

1 comment:

Claudia,Thank you for this clear and articulate article. It is very helpful when somebody like yourself explains what big difference an emotional connection makes to a child. I enjoyed how you stressed that there is not a specific amount of hours needed to achieve that authentic connection, but instead paying close full attention is what makes the difference. I am also very interested in this subject. here is a link to my blog. http://magdalenaspalencia.blogspot.com

the baby connects

About Me

I am a pediatrician and writer with a long-standing interest in addressing children’s mental health needs in a preventive model. I have practiced general and behavioral pediatrics for over 20 years, and currently specialize in early childhood mental health. I am the author of Keeping Your Child in Mind and the forthcoming Listening to Parents and Children (Da Capo) and The Developmental Science of Early Childhood: Clinical Application from Birth through Adolescence (Norton.) I am a graduate of the UMass Boston Infant-Parent Mental Health Post-Graduate Certificate Program, and I am on the faculty of the Brazelton Institute, the Berkshire Psychoanalytic Institute and the Austen Riggs Center.